Provider Demographics
NPI:1629042684
Name:WEAVER, ROBERT S (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MARION ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1167
Mailing Address - Country:US
Mailing Address - Phone:312-320-0341
Mailing Address - Fax:
Practice Address - Street 1:101 N MARION ST
Practice Address - Street 2:SUITE 311
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1167
Practice Address - Country:US
Practice Address - Phone:312-320-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical